Bangladesh records highest preterm birthrate among 103 countries

Infographic: TBS

Bangladesh records 488,600 premature births annually, the highest among 103 countries.

While the country has seen an increase in neonatal care facilities in the last decade, quality concerns persist. Three newborns die every hour in Bangladesh due to prematurity and low birth weight.

Effective policy implementation at all levels is crucial to further decrease premature deaths, experts said at a workshop titled "Dialogue on the Prematurity Burden, Intervention Status, and Innovations in Bangladesh."

The event was jointly organised by Bangabandhu Sheikh Mujib Medical University's (BSMMU) Neonatology Department and AdSEARCH by icddr,b yesterday.

Ahmed Ehsanur Rahman, a scientist at icddr,b, gave a presentation titled "Prematurity Burden, Intervention Status and Innovations in Bangladesh" based on data published in The Lancet.

Ehsanur disclosed that 16.2% of all births in Bangladesh are premature, compared to 13% in India and 14.4% in Pakistan.

Low birth weight (LBW), defined by the World Health Organization (WHO) as less than 2,500 grams, affects 23% of births in Bangladesh.

This places the country second globally among 158 nations for LBW incidence in 2020.

Annually, 700,000 LBW babies and 500,000 premature babies are born, yet fewer than 5% receive proper medical care.

According to WHO, prematurity refers to babies born alive before 37 weeks of pregnancy, while LBW poses additional risks for infant health and survival.

Doctors warned that premature births significantly increase the risk of infant mortality and long-term health complications. Premature babies are prone to cerebral palsy, developmental delays, epilepsy, and blindness, among other issues.

Major (Retd) Dr Laila Arjuman Banu, a gynaecologist, said that several maternal factors contribute to premature births, including infections during pregnancy, uterine abnormalities, high blood pressure, diabetes, and kidney issues.

"In some cases, excessive weight gain during pregnancy or overmedication also plays a role. Treatment is often symptom-based, but a combined effort is essential to prevent premature births," she said, adding that the cause remains unknown in many instances.

Intervention efforts and facility expansion

Over the past decade, Bangladesh has made notable progress in expanding interventions like Kangaroo Mother Care (KMC) and Special Care Newborn Units (Scanu).

Professor Dr Md Abdul Mannan, chairman of BSMMU's Neonatology Department, reported that these interventions have significantly reduced prematurity-related mortality.

The availability of KMC facilities has increased from 57 centres in 2018 to 468 in 2024. The number of newborns admitted to KMC centres grew from 1,462 in 2018 to 19,178 in 2024. However, only 16% of these newborns received quality care.

The lack of functioning baby weighing scales and trained staff remains a significant barrier, particularly in private hospitals, where readiness rates stand at 9%, compared to 57% in public medical colleges and specialised hospitals.

Scanu facilities have also expanded, now available in all 62 districts compared to just two districts in 2011. Despite this progress, 18% of SCANUs still lack functioning radiant warmers, which are critical for managing preterm infants.

Call for policy and systemic changes

Experts at the workshop called for strengthened efforts to address the healthcare system's gaps.

Professor Sanjoy Kumer Dey of BSMMU's Paediatrics Department underscored the importance of breastfeeding campaigns to reduce premature and LBW infant mortality.

Dr Md Jahurul Islam, project manager of the National Newborn Health Programme, highlighted the lack of skilled personnel and adequate equipment in many medical centres outside Dhaka.

"Most centres lack digital weighing machines, and the situation is worse in private facilities, where transparency and willingness to provide information are often absent," he said.

In addition to expanding facilities, experts stressed the need for systemic changes. Antenatal corticosteroids, used to prepare premature babies for early delivery, and other interventions require better accessibility and regulation at all levels.

Panelists at the event pointed out that premature babies often face severe complications, including breathing difficulties and brain bleeding. Steroid injections given shortly before birth significantly reduce these risks, but access remains limited, they said.

Despite substantial progress, further investments in healthcare infrastructure, skilled personnel, and public awareness are crucial to saving lives.

Experts urged policymakers to prioritise these issues to ensure that every newborn receives the care they need to survive and thrive.